Tech for Health – Too Little Too Late (Alam Kasenally)

This week, I feel lucky to have a veteran in healthcare technology and data science from the Silicon Valley, Alam Kasenally, give us an overview on how technology has already transformed healthcare, and the gaping hole which has yet to be filled: patient experience.

Alam recently moved to Mauritius with his wife, Min Xuan (one of Singapore’s brightest entrepreneurs), where they manage a hospital. They’re also busy inspiring youth toward entrepreneurship, and building an innovation hub in Mauritius. Prior to his relocation, Alam worked in Cancer Commons in the Bay Area, which provides patients and their physicians with the knowledge needed to select the best available therapies and trials, and to continuously update that knowledge based on each patient’s response. He also worked in Oracle, Yahoo and Crowdcast prior.

Alam and Min are two people who will inspire you with their commitment to using tech and innovation for public good, how deeply their invest in others, and their entrepreneurial experience. For our entrepreneur readers: If you are a founder trying to gain quick access to real users and customers to pilot quickly, their hospital in Mauritius provides an immediate incubator for medical technologies, while they also have trusted partners especially in the agriculture and tourism verticals that can move quickly. Let me know if you’d like to be in touch!

What’s the opportunity for Tech in Health?

Early Sunday morning, and that ridiculously healthy neighbor of mine is already lunging and squatting on my, I mean our lawn, ready for her half-marathon practice. My overwhelming instinct is to grab my fitbit and try and compete, but really, I should be (from an economist’s point of view) happy that I have an additional neighbor in my community that is healthy. For a start, the workforce is larger by one (and perhaps more than one: serious illnesses affect entire families of people who care for the patient). I enjoy a larger share of tax dollars deployed to Leslie Knope rather than, uh Gregory House. Finally, my neighbor is probably not lunging with a dripping nose. My neighborhood is safer.

So, now we’ve established that Health is a Public Good (as well as being “in the Public Good”), is there therefore a role for technology in Health? Well, there already is, and let’s take a tour of the landscape.

Technology, and I’ll focus on tech as the Valley knows it, minus traditional medical technology (prosthetics, diagnostic and treatment infrastructure, etc) has made a serious impact in the last 10 years. Smart entrepreneurs everywhere have caught on that tech can:

Lower overall costs through automation and efficiency (Epic, the Goliath of the industry, now faces an impressive challenge led by lean startups)

Lower overall costs through the finding of patterns in hospital big data

Avoid adverse selection and moral hazard through finding of patterns in insurance data and monitoring patient behavior (though I have to yet to see these cost-savings trickle down to patients)

Provide a variety of “quantified self” (steps, sleep, calorie, breath) in an effort to influence behavior change and lower their healthcare system’s cost

Lower overall costs through remote monitoring of patients (FBS, SPO2, EKG) and we’re even seeing these devices cross into the consumer space.

So is there any scope for the use of technology left?

There’s scope for a combination of technology, process, regulation and people. Healthcare is not only an expensive good, but a remarkably complex one. Sleep, Dieting, Breathing are just fine (though they have attracted the most VC dollars, as they are the easiest to do). The patient experience, on the other hand, is broken, in a million pieces. The complexity of choosing the institution and doctor that will lead to the best (and most consistent) outcome is daunting. The complexity of referrals is mind-boggling and reimbursement is ludicrous. The simple knowledge of viable treatment options and associated outcomes is not available to patients, their families and even doctors.

Is this the limit of the use of technology for Health? No, it’s only the beginning. It’s time for a true Uber of Healthcare to emerge.

“Huber” re-invents the patient experience just like Uber successfully re-invented the taxi experience. This company (and maybe government) will successfully join different partners and datasets, to create an experience that is to the patient’s (and her family’s) satisfaction, safety and in her interests. Datasets that only get smarter, as Healthcare outcomes, treatment models and patient preference filter back into the system. From my experience, certain countries remain crippled in regulation that thwart such efforts, often with the reasonable but ironic pretext of patient privacy. But others (Singapore comes to mind) have an honest broker, trustworthy IT custodian of the data and could write regulation and create necessary conditions that could well be in the patient’s interest.

Soon, participants will begin to realize that it isn’t just Health that’s the Public Good. But Data. Now, excuse me while I grab my fitbit.

Given that you’ve made some comparison between the US healthcare system and Singapore- Would you say that the opportunity for a consumer facing health service focused on the patient’s experience is smaller in Singapore compared to the US? If someone wanted to start Huber in Singapore, where would be a good place to focus on first?

Thank you for your two pertinent questions.
For your first question, the answer is probably YES.

Singapore has a smaller available population, and if constructed as, as you suggest, a “consumer facing health service focused on the patient’s experience”, much of your expense will be customizing to the local patient workflow. Reaching a global audience will then involve a large amount of regional customization.

For your second question, I will begin by assuming that the kind of Huber you want to build is a true open ecosystem, and not a closed one like Uber has in fact built.

At my previous venture, we made the reasonable gamble of beginning with product, with the following rationale:
Product -> Patients -> Data -> Alliances -> Ecosystem

Because the second step was a lot more expensive than we had thought, I’d do things differently this way: work on Alliances much earlier, and build their part of the ecosystem as part of your product. The following line of thinking might be possible:

– What is the patient’s current workflow? What are the major pain points in the process (cost, uncertainty, time)?
– Who are those who sell services to the patient? What are their workflows, pain points, and major challenges in reaching the patient?

From this, design the patient experience (and partner experience) from that

Thanks Alam, that makes sense to me. Just a quick question, what kind of alliances are you referring to, would that be partnerships with hospitals or medical groups whereby they would get some value from using your product, and in return, they would both invest in product development as well as have some buy in as a stakeholder of the final product?